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Chiefari E, Innaro N, Gervasi R, Mirabelli M, Giuliano S, Donnici A, Obiso S, Brunetti FS, Foti DP, Brunetti A. Incidental thyroid carcinoma in an endemic goiter area in Italy: histopathological features and predictors of a common finding. Endocrine 2024; 84:589-597. [PMID: 38217773 PMCID: PMC11076372 DOI: 10.1007/s12020-023-03659-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Accepted: 12/10/2023] [Indexed: 01/15/2024]
Abstract
PURPOSE The occurrence and histopathological features of incidental thyroid carcinoma (ITC) vary considerably among populations from different geographical regions. The aim of this study is to assess the prevalence and histopathological characteristics of ITC in patients who underwent thyroid surgery for apparently benign thyroid diseases in an endemic goiter area in Italy. METHODS A total of 649 consecutive patients (531 females and 118 males; mean age, 52.9 ± 11.0 years), who underwent thyroid surgery at the Endocrine Surgery Unit of the tertiary care "Renato Dulbecco" University Hospital (Catanzaro, Italy) in the period between years 2017 and 2022, were included in this retrospective study. A comprehensive histopathological examination was performed on surgically excised thyroid tissue. Logistic regression analysis was employed to identify potential predictors of ITC. RESULTS The histopathological examination revealed the presence of ITC in 81 patients, accounting for 12.5% of the total study population. The female to male ratio was found to be 6.4 to 1. Among the patients with ITC, 72 had papillary carcinoma (PTC), with 53 of these tumors being microcarcinomas (microPTC). Additionally, 5 patients had follicular thyroid carcinoma, 2 patients had low-risk follicular cell-derived thyroid neoplasms, 1 patient had an oncocytic carcinoma, and 1 patient had a medullary thyroid carcinoma. Logistic regression analysis demonstrated a significant association between female sex and incidental microPTC. CONCLUSIONS These findings provide further evidence of the common occurrence of ITC, typically in the form of microPTC, among individuals who undergo thyroid surgery for apparently benign thyroid diseases.
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Affiliation(s)
- Eusebio Chiefari
- Department of Health Sciences, University of "Magna Græcia" Catanzaro, 88100, Catanzaro, Italy
| | - Nadia Innaro
- Operative Unit of Endocrine Surgery, University Hospital "Renato Dulbecco", 88100, Catanzaro, Italy
| | - Rita Gervasi
- Operative Unit of Endocrine Surgery, University Hospital "Renato Dulbecco", 88100, Catanzaro, Italy
| | - Maria Mirabelli
- Department of Health Sciences, University of "Magna Græcia" Catanzaro, 88100, Catanzaro, Italy
| | - Stefania Giuliano
- Operative Unit of Endocrinology, University Hospital "Renato Dulbecco", 88100, Catanzaro, Italy
| | - Alessandra Donnici
- Operative Unit of Endocrinology, University Hospital "Renato Dulbecco", 88100, Catanzaro, Italy
| | - Stefania Obiso
- Operative Unit of Endocrinology, University Hospital "Renato Dulbecco", 88100, Catanzaro, Italy
| | - Francesco S Brunetti
- Department of Health Sciences, University of "Magna Græcia" Catanzaro, 88100, Catanzaro, Italy
| | - Daniela Patrizia Foti
- Department of Experimental and Clinical Medicine, University of "Magna Græcia" Catanzaro, 88100, Catanzaro, Italy
| | - Antonio Brunetti
- Department of Health Sciences, University of "Magna Græcia" Catanzaro, 88100, Catanzaro, Italy.
- Operative Unit of Endocrinology, University Hospital "Renato Dulbecco", 88100, Catanzaro, Italy.
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Seminati D, Mane E, Ceola S, Casati G, Putignano P, Garancini M, Gatti A, Leni D, Pincelli AI, Fusco N, L’Imperio V, Pagni F. An Indeterminate for Malignancy FNA Report Does Not Increase the Surgical Risk of Incidental Thyroid Carcinoma. Cancers (Basel) 2022; 14:cancers14215427. [PMID: 36358845 PMCID: PMC9657155 DOI: 10.3390/cancers14215427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Revised: 10/27/2022] [Accepted: 11/01/2022] [Indexed: 11/06/2022] Open
Abstract
Incidental thyroid carcinomas (ITCs) are a fairly frequent finding in daily routine practice, with papillary thyroid microcarcinoma being the most frequent entity. In our work, we isolated incidental cases arising in thyroids removed for other cytologically indeterminate and histologically benign nodules. We retrospectively retrieved cases with available thyroid Fine Needle Aspiration (FNA, 3270 cases), selecting those with an indeterminate cytological diagnosis (Bethesda classes III−IV, 652 cases). Subsequently, we restricted the analysis to surgically treated patients (163 cases) finding an incidental thyroid carcinoma in 22 of them. We found a 13.5% ITC rate, with ITCs representing 46.8% of all cancer histologically diagnosed in this indeterminate setting. Patients received a cytological diagnosis of Bethesda class III and IV in 41% and 59% of cases, respectively. All ITC cases turned out to be papillary thyroid microcarcinomas; 36% of cases were multifocal, with foci bilaterally detected in 50% of cases. We found an overall ITC rate concordant with the literature and with our previous findings. The assignment of an indeterminate category to FNA did not increase the risk of ITCs in our cohort. Rather, a strong statistical significance (p < 0.01) was found comparing the larger size of nodules that underwent FNA and the smaller size of their corresponding ITC nodule.
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Affiliation(s)
- Davide Seminati
- Department of Pathology, University of Milano—Bicocca (UNIMIB), 20900 Monza, Italy
- Correspondence:
| | - Eltjona Mane
- Department of Pathology, University of Milano—Bicocca (UNIMIB), 20900 Monza, Italy
| | - Stefano Ceola
- Department of Pathology, University of Milano—Bicocca (UNIMIB), 20900 Monza, Italy
| | - Gabriele Casati
- Department of Pathology, University of Milano—Bicocca (UNIMIB), 20900 Monza, Italy
| | - Pietro Putignano
- Endocrinology, ASST Monza, San Gerardo Hospital, 20900 Monza, Italy
| | | | - Andrea Gatti
- Surgery, ASST Monza, San Gerardo Hospital, 20900 Monza, Italy
| | - Davide Leni
- Radiology ASST Monza, San Gerardo Hospital, 20900 Monza, Italy
| | | | - Nicola Fusco
- Division of Pathology, IEO, European Institute of Oncology IRCCS, 20141 Milan, Italy
| | - Vincenzo L’Imperio
- Department of Pathology, University of Milano—Bicocca (UNIMIB), 20900 Monza, Italy
| | - Fabio Pagni
- Department of Pathology, University of Milano—Bicocca (UNIMIB), 20900 Monza, Italy
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Al Essa M, Doubi A, Aldosari L, Alkhaldi A, Alzahrani M, Alsadi M, Alsalem A. Risk of thyroid carcinoma in patients treated surgically with assumed benign cytology in Riyadh, Saudi Arabia. ACTA OTORHINOLARYNGOLOGICA ITALICA 2022; 42:237-242. [PMID: 35880364 PMCID: PMC9330754 DOI: 10.14639/0392-100x-n1903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/06/2021] [Accepted: 03/14/2022] [Indexed: 11/23/2022]
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Rodrigues MG, da Silva LFF, Araujo-Filho VJFD, Mosca LDM, Araujo-Neto VJFD, Kowalski LP, Carneiro PC. Incidental thyroid carcinoma: Correlation between FNAB cytology and pathological examination in 1093 cases. Clinics (Sao Paulo) 2022; 77:100022. [PMID: 35306374 PMCID: PMC8941178 DOI: 10.1016/j.clinsp.2022.100022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Accepted: 12/08/2021] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE To investigate Incidental Thyroid Carcinoma (ITC) by comparing the results of Fine Needle Aspiration Biopsy (FNAB) cytology and the postoperative pathological findings. METHODS Data of 1479 patients who underwent total thyroidectomy were retrieved. Three hundred eighty-six patients were excluded due to insufficient data. Each surgical specimen studied received two histopathological diagnoses: the local diagnosis ‒ for the same area in which the FNAB was performed; and the final diagnosis, which includes a study of the entire surgical specimen. RESULTS A thousand and ninety-three patients were investigated. FNAB result was malignant in 187 patients, benign in 204, suspicious or indeterminate in 668 cases, and inconclusive in 34 cases. The prevalence of ITC was 15.1%. Most of the ITC in this series was less than 0.5 cm. The incidence of ITC was higher in Bethesda III (17.5% ITC) and IV (19% ITC) than in Bethesda II cases (1.5% false negatives and 9% ITC). CONCLUSION Although the incidence of false-negative results in Bethesda II nodules is only 1.5%, 9% of these patients had ITC in the thyroid parenchyma outside the nodule that underwent preoperative FNAB. The incidence of ITC in the same scenario was even higher in Bethesda III (17.5%) and Bethesda IV cases (19%). Ultrasonography-guided FNAB is an excellent method for the assessment of thyroid nodules. However, biopsy sites should be carefully selected. Despite the high incidence of incidentalomas, total thyroidectomy should not always be the treatment of choice due to its rare but potentially serious complications. The findings of the present study can assist future clinical decisions towards active surveillance strategies for the management of papillary thyroid carcinoma.
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Affiliation(s)
- Mariana Gonçalves Rodrigues
- Departamento de Cirurgia, Cirurgia de Cabeça e Pescoço, Faculdade de Medicina FMUSP, Universidade de São Paulo, São Paulo, SP, Brazil.
| | | | | | - Letícia de Moraes Mosca
- Departamento de Cirurgia, Cirurgia de Cabeça e Pescoço, Faculdade de Medicina FMUSP, Universidade de São Paulo, São Paulo, SP, Brazil
| | | | - Luiz Paulo Kowalski
- Departamento de Cirurgia, Cirurgia de Cabeça e Pescoço, Faculdade de Medicina FMUSP, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Paulo Campos Carneiro
- Departamento de Patologia, Faculdade de Medicina FMUSP, Universidade de São Paulo, São Paulo, SP, Brazil.
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Damaskos C, Garmpis N, Dimitroulis D, Kyriakos G, Diamantis E. Is There a Correlation of TSI Levels and Incidental Papillary Thyroid Carcinoma in Graves Disease? A Review of the Latest Evidence. ACTA MEDICA (HRADEC KRALOVE) 2021; 64:200-203. [PMID: 35285441 DOI: 10.14712/18059694.2022.2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
PURPOSE Our aim is to clarify if there is an association between the TSI levels and the development of thyroid carcinoma in patients with Grave's disease. METHODS A systematic search concerning original studies from 2010 to 2020 was carried out through the databases PubMed, EMBASE and Cochrane, according to the PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) guidelines. The terms used are 'Graves' disease' and /or 'Incidental Papillary thyroid cancer' and 'TSI' levels. Retrospective studies upon the subject were concluded in the analysis. RESULTS Only three retrospective studies were found involving 916 patients with Graves' disease and Euthyroid goiter. No significant correlation has been found between TSI and the occurrence of thyroid carcinoma in patients with Graves' disease. CONCLUSION Very little research has been conducted upon the subject. More assays are required in order to identify a possible prognostic role of TSI levels in Papillary thyroid carcinoma in patients with Graves disease.
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Affiliation(s)
- Christos Damaskos
- N.S. Christeas Laboratory of Experimental Surgery and Surgical Research, Medical School, National and Kapodistrian University of Athens, Athens, Greece.
- Renal Transplantation Unit, Laiko General Hospital, Athens, Greece.
| | - Nikolaos Garmpis
- N.S. Christeas Laboratory of Experimental Surgery and Surgical Research, Medical School, National and Kapodistrian University of Athens, Athens, Greece
- Second Department of Propedeutic Surgery, Laiko General Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Dimitrios Dimitroulis
- Second Department of Propedeutic Surgery, Laiko General Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Georgios Kyriakos
- Seccion de Endocrinologia y Nutrition, Hospital General Universitario Santa Lucia, Cartagena, Spain
| | - Evangelos Diamantis
- Endocrinology Unit of Academic Department of Internal Medicine, Agioi Anargyroi General Oncology Hospital, National and Kapodistrian University of Athens, Kifisia, Greece
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Maurer E, Vorländer C, Zielke A, Dotzenrath C, von Frankenberg M, Köhler H, Lorenz K, Weber T, Jähne J, Hammer A, Böttcher KA, Schwarz K, Klinger C, Buhr HJ, Bartsch DK. Short-Term Outcomes of Surgery for Graves' Disease in Germany. J Clin Med 2020; 9:jcm9124014. [PMID: 33322553 PMCID: PMC7763951 DOI: 10.3390/jcm9124014] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Revised: 11/29/2020] [Accepted: 12/07/2020] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Surgical treatment of Graves' disease (GD) has a potentially increased incidence of postoperative hypoparathyroidism, recurrent laryngeal nerve palsy (RLNP) and bleeding. The aim of this study was to evaluate the current extent of surgery for the treatment of GD and its safety as a short-term outcome. METHODS Patients who underwent thyroid resection for GD were identified from the prospective StuDoQ/Thyroid registry. Patient data were retrospectively analyzed regarding demographics, surgical procedures and perioperative outcomes. Statistics were performed with Student's t-test or Fisher's exact test and multivariate Cox regression analysis. The level of statistical significance was set at p < 0.05. RESULTS A total of 1808 patients with GD with a median age of 44 (range 14-85) years were enrolled in a 25-month period by 78 departments, of which 35.7% (n = 645) had an endocrine orbitopathy and 0.1% (n = 6) had thyrotoxic crisis. Conventional open surgery was used in 98.6% of cases and minimally invasive or remote-access approaches were used in 1.4%. Total thyroidectomy was performed in 93.4% of cases (n = 1688). Intraoperative neuromonitoring (IONM) was used in 98.9% (n = 1789) of procedures. In 98.3% (n = 1777) at least one parathyroid gland was visualized and in 20.7% (n = 375) parathyroids were autografted. The rates of unilateral and bilateral transient RLNP were 3.9% (n = 134/3429 nerves at risk) and 0.1% (n = 4/3429 NAR). The rates of transient RLNP tended to be higher when intermittent IONM was used compared to continuous IONM (4.1% vs. 3.4%, p < 0.059). The rate of transient postoperative hypoparathyroidism was overall 29% (n = 525/1808). Multivariate analysis revealed fewer than 300 thyroid resections and fewer than 15 thyroid resections for GD per year, male sex, BMI > 30, autotransplantation of parathyroid glands and previous bilateral thyroid surgery as independent risk factors for postoperative temporary hypoparathyroidism. Reoperations for bleeding (1.3%) were rare. CONCLUSION Total thyroidectomy with IONM is safe and currently the most common surgical therapy for GD in Germany. Postoperative hypoparathyroidism is the major complication which should be focused on.
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Affiliation(s)
- Elisabeth Maurer
- Department of Visceral, Thoracic and Vascular Surgery, Philipps University Marburg Baldingerstrasse, 35043 Marburg, Germany;
- Correspondence:
| | - Christian Vorländer
- Department of Endocrine Surgery, Bürgerhospital Frankfurt/Main, 60318 Frankfurt am Main, Germany;
| | - Andreas Zielke
- Department of Endocrine Surgery, Diakonie-Klinikum Stuttgart, 70176 Stuttgart, Germany;
| | - Cornelia Dotzenrath
- Department of Endocrine Surgery, Helios Universityhospital Wuppertal, 42283 Wuppertal, Germany;
| | | | - Hinrich Köhler
- Department of General Surgery, Herzogin Elisabeth Hospital Braunschweig, 38124 Braunschweig, Germany;
| | - Kerstin Lorenz
- Department of Visceral, Vascular and Endocrine Surgery, University Medical Center Halle, 06120 Halle, Germany;
| | - Theresia Weber
- Department of Endocrine Surgery, Katholisches Klinikum Mainz, 55131 Mainz, Germany;
| | - Joachim Jähne
- Department of General and Visceral Surgery, Diakovere Henriettenstift Hannover, 30171 Hannover, Germany;
| | - Antonia Hammer
- Department of Endocrine Surgery, DKD Helios Clinic Wiesbaden, 65191 Wiesbaden, Germany;
| | - Knut A. Böttcher
- Department of General and Visceral Surgery, Diakonissen Hospital Mannheim, 68163 Mannheim, Germany;
| | - Katharina Schwarz
- Department of Endocrine Surgery, Lukas Hospital GmbH Neuss, 41464 Neuss, Germany;
| | - Carsten Klinger
- German Society of General and Visceral Surgery, 10117 Berlin, Germany; (C.K.); (H.J.B.)
| | - Heinz J. Buhr
- German Society of General and Visceral Surgery, 10117 Berlin, Germany; (C.K.); (H.J.B.)
| | - Detlef K. Bartsch
- Department of Visceral, Thoracic and Vascular Surgery, Philipps University Marburg Baldingerstrasse, 35043 Marburg, Germany;
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Wilson M, Patel A, Goldner W, Baker J, Sayed Z, Fingeret AL. Postoperative thyroid hormone supplementation rates following thyroid lobectomy. Am J Surg 2020; 221:804-808. [PMID: 32682499 DOI: 10.1016/j.amjsurg.2020.07.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2019] [Revised: 03/30/2019] [Accepted: 07/03/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND Thyroid lobectomy is performed for symptomatic benign nodules, indeterminate nodules, or low-risk well differentiated thyroid cancer. We aimed to determine factors associated with thyroid stimulating hormone over goal (TH) following lobectomy. METHODS We performed a retrospective single-institution cohort study of patients undergoing thyroid lobectomy from January 2016 to December 2017. TH was defined as need for thyroid hormone in accordance with guidelines. Univariate and multivariate logistic regression analysis was performed. RESULTS One hundred patients were included and 47% developed. TH: 73% of those with cancer, 38% with benign pathology (p = 0.002). Patients with TH were more likely to have thyroiditis 26% versus 3.8% (p = 0.002); higher preoperative TSH: mean 1.88mIU/L (SD 1.17) versus 1.16mIU/L (SD 0.77) (p = 0.0002), and smaller remnant thyroid lobe adjusted for body surface area 2.99ml/m2 versus 3.72ml/m2 (p = 0.003). CONCLUSIONS After thyroid lobectomy, TH is associated with preoperative TSH level, thyroiditis, remnant thyroid volume, and malignancy. The majority of patients with final pathology of carcinoma will require thyroid hormone supplementation to achieve TSH goal.
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Affiliation(s)
| | - Anery Patel
- Department of Medicine, Division of Diabetes, Endocrinology, and Metabolism, University of Nebraska Medical Center, USA
| | - Whitney Goldner
- Department of Medicine, Division of Diabetes, Endocrinology, and Metabolism, University of Nebraska Medical Center, USA
| | - John Baker
- Department of Pathology and Microbiology, University of Nebraska Medical Center, USA
| | - Zafar Sayed
- Department of Otolaryngology, Division of Head and Neck Oncology, University of Nebraska Medical Center, USA
| | - Abbey L Fingeret
- Department of Surgery, Division of Surgical Oncology, University of Nebraska Medical Center, USA.
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Wilson M, Patel A, Goldner W, Baker J, Sayed Z, Fingeret AL. Postoperative thyroid hormone supplementation rates following thyroid lobectomy. Am J Surg 2020; 220:1169-1173. [PMID: 32684294 DOI: 10.1016/j.amjsurg.2020.06.052] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Revised: 04/24/2020] [Accepted: 06/25/2020] [Indexed: 12/27/2022]
Abstract
BACKGROUND Thyroid lobectomy is performed for symptomatic benign nodules, indeterminate nodules, or low-risk well-differentiated thyroid cancer. We aimed to determine factors associated with need for thyroid hormone supplementation following thyroid lobectomy. METHODS We performed a retrospective single-institution cohort study of patients undergoing thyroid lobectomy from January 2016 to December 2017. Thyroid hormone supplementation was assessed postoperatively based on guidelines for thyroid stimulating hormone (TSH) level goal for benign (0.5-4.5mIU/L) or malignant (<2mIU/L) final pathology. Univariate and multivariate logistic regression analysis was performed. RESULTS One hundred patients were included and overall 47% required thyroid hormone supplementation after thyroid lobectomy: 73% of those with cancer, 38% with benign pathology (p = 0.002). Patients requiring thyroid hormone supplementation were more likely to have thyroiditis 26% versus 3.8% of those who remained euthyroid (p = 0.002); have a higher preoperative TSH: mean 1.88mIU/L (SD 1.17) versus 1.16mIU/L (SD 0.77) (p = 0.0002), and have a smaller remnant thyroid lobe adjusted for body surface area 2.99ml/m2 versus 3.72ml/m2 (p = 0.003). CONCLUSIONS After thyroid lobectomy, the need for thyroid hormone supplementation is associated with higher preoperative TSH level, thyroiditis, remnant thyroid volume, and malignancy on final pathology. The majority of patients with final pathology of carcinoma will require thyroid hormone supplementation to achieve TSH goal. For patients with benign pathology after thyroid lobectomy the majority will not require thyroid hormone supplementation to achieve TSH goal.
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Affiliation(s)
| | - Anery Patel
- Department of Medicine, Division of Diabetes, Endocrinology and Metabolism, University of Nebraska Medical Center, USA
| | - Whitney Goldner
- Department of Medicine, Division of Diabetes, Endocrinology and Metabolism, University of Nebraska Medical Center, USA
| | - John Baker
- Department of Pathology and Microbiology, University of Nebraska Medical Center, USA
| | - Zafar Sayed
- Department of Otolaryngology, Division of Head and Neck Oncology, University of Nebraska Medical Center, USA
| | - Abbey L Fingeret
- Department of Surgery, Division of Surgical Oncology, University of Nebraska Medical Center, USA.
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Loomans-Kropp HA, Dunn BK, Kramer BS, Pinsky P. Thyroid Incidentalomas in Association With Low-Dose Computed Tomography in the National Lung Screening Trial. Am J Epidemiol 2020; 189:27-33. [PMID: 31595954 DOI: 10.1093/aje/kwz219] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2019] [Accepted: 09/18/2019] [Indexed: 02/06/2023] Open
Abstract
Advances in cancer screening methods have opened avenues for incidental findings and cancer overdiagnosis. We performed a secondary analysis of the National Lung Screening Trial (enrollment from 2002-2004), a randomized controlled trial comparing low-dose computed tomography (LDCT; n = 26,722) with chest radiography (CXR; n = 26,732) for lung cancer detection, to examine incidental findings related to thyroid cancer (ThCa). Three screening rounds were included, and median follow-up was 6.6 years for LDCT and 6.5 years for CXR. Radiologists reported lung and non-lung-related abnormalities. In the LDCT arm, 5.7%, 4.7%, and 4.5% of participants had abnormalities above the diaphragm (AADs) detected at baseline, year 1, and year 2, respectively, compared with 2.3%, 1.5%, and 1.3% in the CXR arm. In the LDCT arm, 205 AADs (7.0%) were thyroid-related. Overall, 60 ThCas were reported, 35 in the LDCT arm and 25 in the CXR arm (P = 0.2). In the LDCT arm, participants with a prior AAD had a 7.8-fold increased risk (95% confidence interval: 4.0, 15.1) of ThCa compared with those who did not have an AAD. Early and persistent excess of ThCas diagnosed earlier in the LDCT arm suggests overdiagnosis. The use of sensitive screening modalities for early detection of lung cancer might result in the discovery of thyroid incidentalomas.
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Affiliation(s)
- Holli A Loomans-Kropp
- Cancer Prevention Fellowship Program, Division of Cancer Prevention, National Cancer Institute, Rockville, Maryland
- Gastrointestinal and Other Cancers Branch, Division of Cancer Prevention, National Cancer Institute, Rockville, Maryland
| | - Barbara K Dunn
- Biometry Research Group, Division of Cancer Prevention, National Cancer Institute, Rockville, Maryland
| | - Barnett S Kramer
- Division of Cancer Prevention, National Cancer Institute, Rockville, Maryland
| | - Paul Pinsky
- Early Detection Research Branch, Division of Cancer Prevention, National Cancer Institute, Rockville, Maryland
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Maturo A, Tromba L, De Anna L, Carbotta G, Livadoti G, Donello C, Falbo F, Galiffa G, Esposito A, Biancucci A, Carbotta S. Incidental thyroid carcinomas. A retrospective study. G Chir 2019; 38:94-101. [PMID: 28691675 DOI: 10.11138/gchir/2017.38.2.094] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
AIM The aim of the present study is to report our series of incidental thyroid carcinomas in the last 15 years and their follow-up, discussing therapeutics indications and surgical choices. PATIENTS AND METHODS We have considered 1793 patients operated on Surgical Sciences Department of "Sapienza" University of Rome from January 1, 2001 to December 31, 2015. The study was conducted on 83 totally thyroidectomized patients with a real incidental thyroid carcinoma, by clinical, laboratory and instrumental controls. Whole-body scan was the most important test in postoperative evaluation. RESULTS In our series, the incidence of incidental carcinomas was 4.62%. Compared to the total number of cancer patients, the percentage is 21,9%. In 15.66% of cases there was multifocality and in 7.23% also bilaterality. Regarding the histological type, in all cases they were papillary carcinoma. The size of the neoplastic lesions ranged from a minimum of 3 to a maximum of 10 mm. Whole-body scan revealed lymph node metastasis in 57.69% of patients. DISCUSSION Comparing these data with our previous studies we have seen a significant increase in incidence of incidental thyroid carcinomas over the years. Our therapeutical choice is total thyroidectomy and complection thyroidectomy after lobectomy, because of a relevant percentage of multifocality and/or bilaterality of these tumors. Many Authors on the contrary prefer a more conservative approach invoking the good prognosis of these tumors. The 57.69% of lymph node metastasis at postoperative whole-body scan comfort us in our setting. CONCLUSION Incidental thyroid carcinomas are not uncommon. We consider only tumors until 1 cm in diameter. Multifocality and bilaterality are often present such as occult lymph node metastasis. Our therapeutical choice is total thyroidectomy in order to conduct a proper follow-up.
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Prete FP, Marzaioli R, Lattarulo S, Paradies D, Barile G, d’Addetta MV, Tomasicchio G, Gurrado A, Pezzolla A. Transaxillary robotic-assisted thyroid surgery: technique and results of a preliminary experience on the Da Vinci Xi platform. BMC Surg 2019; 18:19. [PMID: 31074396 PMCID: PMC7402570 DOI: 10.1186/s12893-019-0473-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Accepted: 01/04/2019] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Robotic thyroidectomy by transaxillary approach (RATS) is regarded as a feasible and safe alternative procedure in selected patients with benign disease or thyroid cancer of low risk, facilitating thyroidectomy with respect to conventional endoscopic approach and offering improved cosmetic results. The Da Vinci Xi surgical system (Intuitive Surgical, Sunnyvale, CA, USA) presents technical advantages over its previous generations, including overhead docking, more compact robotic arms, extended range of motion, and ability for camera to be docked in any arm. This construct supports dissection in smaller spaces with less arm interference and improved view. We present an initial experience of RATS on DVSS Xi in an academic Centre in Italy. METHODS We conducted a prospective observational study, involving patients with thyroid disease and treated between April 2016 and January 2018. A modified thyroidectomy retractor (Modena retractor, CEATEC Medizintechnik, Germany) was used to lift a musculocutaneous flap and operate gasless. Instrument placement was recorded for each procedure. Each procedure description was broken down into three phases, creation of working space, machine docking with instrument positioning and endoscopic operating technique. Duration of cases was recorded. Patients selected were young women, BMI < 30, thyroid nodule < 5 cm, cytology TIR2 to TIR4 (TIR4:only nodules < 1 cm diameter). RESULTS Twelve RATS were performed within the learning curve for the robotic technique, 10 lobectomies and 2 total thyroidectomies. No patients required reintervention. Mean duration of surgery was 198.9 min for lobectomy and 210 for thyroidectomy. The same surgical team performed all procedures. No patients presented surgery-related complications, mean stay was 3 days. Decrease in operating time was observed after 8 cases along with more precise preparation of working space. Four arms were used in the first 10 procedures then only three. No recurrent laryngeal nerve dysfunction, no seroma or haematoma were recorded. One patient had transient hypocalcaemia after total thyroidectomy. CONCLUSIONS Since the early phases of a preliminary experience RATS appeared a safe alternative to open thyroidectomy. Uptake of technique was quick on Xi platform with few technical tweaks over techniques described for Si machines. Careful patient selection is crucial. TRIAL REGISTRATION Retrospectively registered on 20 july 2018 . TRIAL REGISTRATION NUMBER researchregistry4272. The Research Registry: https://www.researchregistry.com/browse-the-registry#home/registrationdetails/5b517f08dbc2045aefd7f9b4/.
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Affiliation(s)
- Francesco Paolo Prete
- Department of Emergency and Organ Transplant - Minimally invasive and Endocrine Surgery Unit, University Medical School of Bari, Bari, Italy
| | - Rinaldo Marzaioli
- Department of Emergency and Organ Transplant - Minimally invasive and Endocrine Surgery Unit, University Medical School of Bari, Bari, Italy
| | - Serafina Lattarulo
- Department of Emergency and Organ Transplant - Minimally invasive and Endocrine Surgery Unit, University Medical School of Bari, Bari, Italy
| | - Daniele Paradies
- Department of Emergency and Organ Transplant - Minimally invasive and Endocrine Surgery Unit, University Medical School of Bari, Bari, Italy
| | - Graziana Barile
- Department of Emergency and Organ Transplant - Minimally invasive and Endocrine Surgery Unit, University Medical School of Bari, Bari, Italy
- Department of Surgical Oncology – IRCCS Istituto Tumori “Giovanni Paolo II”, Bari, Italy
| | - Maria Vittoria d’Addetta
- Department of Emergency and Organ Transplant - Minimally invasive and Endocrine Surgery Unit, University Medical School of Bari, Bari, Italy
| | - Giovanni Tomasicchio
- Department of Emergency and Organ Transplant - Minimally invasive and Endocrine Surgery Unit, University Medical School of Bari, Bari, Italy
| | - Angela Gurrado
- Department of Biomedical Science and Human Oncology - Emergency, Digestive and Endocrine Surgery Unit, University Medical School of Bari, Bari, Italy
| | - Angela Pezzolla
- Department of Emergency and Organ Transplant - Minimally invasive and Endocrine Surgery Unit, University Medical School of Bari, Bari, Italy
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Reoperative central lymph node dissection for incidental papillary thyroid cancer can be performed safely: A retrospective review. Int J Surg 2018; 56:102-107. [DOI: 10.1016/j.ijsu.2018.06.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Revised: 04/10/2018] [Accepted: 06/12/2018] [Indexed: 11/20/2022]
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13
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Christakis I, Dimas S, Kafetzis ID, Roukounakis N. Risk stratification of 282 differentiated thyroid cancers found incidentally in 1369 total thyroidectomies according to the 2015 ATA guidelines; implications for management and treatment. Ann R Coll Surg Engl 2018; 100:357-365. [PMID: 29484944 PMCID: PMC5956592 DOI: 10.1308/rcsann.2018.0017] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/03/2017] [Indexed: 12/19/2022] Open
Abstract
Introduction The purpose of this study was to evaluate the incidence of incidental differentiated thyroid carcinoma in thyroid operations for a benign preoperative diagnosis, to identify the risk factors involved and to risk stratify the cancer patients according to the 2015 American Thyroid Association (ATA) guidelines. Materials and methods The study was a retrospective review of all thyroidectomy operations performed in a single institution (January 2004 to January 2009). We excluded patients with a preoperative diagnosis of thyroid malignancy. Results Incidental differentiated thyroid carcinoma was diagnosed in 282/1369 patients (21%). The incidental group had a significantly higher number of males (19% vs 14%, P = 0.033) and a higher number of patients with histopathological evidence of thyroiditis (35% vs 25%, P = 0.004). There was a higher number of lymph nodes present in the incidental group but numbers did not reach statistical significance (17% vs 13%, P = 0.079). There were 270 cases in the ATA low-risk group (96%) and 12 cases in the ATA intermediate-risk group (4%). Patients with an ATA intermediate risk had a statistically higher number of capsule invasion, extrathyroidal extension and angioinvasion (P < 0.001, P < 0.001 and P < 0.001, respectively). Overall, 22% of patients with an incidental differentiated thyroid carcinoma should be considered for radioactive iodine 131I treatment. 29 of the 191 patients in American Joint Committee on Cancer stage I should be considered for radioactive iodine treatment (15%). Conclusions Males and patients with thyroiditis are at a higher risk for an incidental differentiated thyroid carcinoma. One of every five of patients diagnosed with cancer will need radioactive iodine treatment, even some patients with stage I disease.
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MESH Headings
- Adenocarcinoma, Follicular/diagnosis
- Adenocarcinoma, Follicular/epidemiology
- Adenocarcinoma, Follicular/surgery
- Adenocarcinoma, Follicular/therapy
- Adenoma, Oxyphilic/diagnosis
- Adenoma, Oxyphilic/epidemiology
- Adenoma, Oxyphilic/surgery
- Adenoma, Oxyphilic/therapy
- Adolescent
- Adult
- Aged
- Aged, 80 and over
- Carcinoma/diagnosis
- Carcinoma/epidemiology
- Carcinoma/surgery
- Carcinoma/therapy
- Carcinoma, Papillary/diagnosis
- Carcinoma, Papillary/epidemiology
- Carcinoma, Papillary/surgery
- Carcinoma, Papillary/therapy
- Female
- Humans
- Incidence
- Incidental Findings
- Male
- Middle Aged
- Neoplasm Invasiveness
- Practice Guidelines as Topic
- Retrospective Studies
- Risk Assessment
- Risk Factors
- Thyroid Cancer, Papillary
- Thyroid Neoplasms/diagnosis
- Thyroid Neoplasms/epidemiology
- Thyroid Neoplasms/surgery
- Thyroid Neoplasms/therapy
- Thyroidectomy
- Young Adult
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Affiliation(s)
- I Christakis
- Department of Endocrine Surgery, Churchill Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - S Dimas
- Department of Endocrine Surgery, Mediterraneo Hospital, Athens, Greece
| | - ID Kafetzis
- Department of Endocrine Surgery, Errikos Dunant Hospital Center, Athens, Greece
| | - N Roukounakis
- First Department of General Surgery and Transplantation, ‘Evangelismos‘ General Hospital, Athens, Greece
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Fama F, Sindoni A, Cicciu M, Polito F, Piquard A, Saint-Marc O, Gioffre-Florio M, Benvenga S. Preoperatively undiagnosed papillary thyroid carcinoma in patients thyroidectomized for benign multinodular goiter. ARCHIVES OF ENDOCRINOLOGY AND METABOLISM 2018; 62:139-148. [PMID: 29641730 PMCID: PMC10118985 DOI: 10.20945/2359-3997000000017] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/18/2016] [Accepted: 10/03/2017] [Indexed: 11/23/2022]
Abstract
OBJECTIVE Incidental thyroid cancers (ITCs) are often microcarcinomas; among them, the most frequent histotype is the papillary one. The purpose of this study was to evaluate the rate of papillary thyroid cancer (PTC) in patients thyroidectomized for benign multinodular goiter. SUBJECT AND METHODS We retrospectively evaluated the histological incidence of PTC in 207 consecutive patients who, in a 1-year period, underwent thyroidectomy for benign multinodular goiter. All patients came from an iodine-deficient area (Orleans, France) with three nuclear power stations located in the neighboring areas of the county town. RESULTS Overall, 25 thyroids (12.1%) harbored 37 PTC, of which 31 were microcarcinomas. In these 25 PTC patients, mean age was 55 ± 10 years (range 30-75), female:male ratio 20:5 (4:1). In 10 patients (40% of 25 and 4.8% of 207), PTCs were bilateral, and in 7 (2 with microPTCs) the thyroid capsule was infiltrated. These 7 patients underwent central and lateral cervical lymph node dissections, which revealed lymph node metastases in one and two cases, respectively. Radioiodine treatment was performed in 7 cases. Neither mortality nor transient and permanent nerve injuries were observed. Four (16%) transient hypocalcaemias occurred as early complications. At last follow-up visit (mean length of follow-up 17.2 ± 3.4 months), all patients were doing well and free of any clinical local recurrence or distant metastases. CONCLUSION With a 12% risk that multinodular goiter harbors preoperatively unsuspected PTCs, which can have already infiltrated the capsule and that can be accompanied by PTC foci contralaterally, an adequate surgical approach has to be considered.
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Affiliation(s)
- Fausto Fama
- Department of Human Pathology in Adulthood and Childhood "G. Barresi", University Hospital of Messina, Messina, Italy
| | - Alessandro Sindoni
- Department of Biomedical and Dental Sciences and of Morphological and Functional Images, University Hospital of Messina, Messina, Italy
| | - Marco Cicciu
- Department of Human Pathology in Adulthood and Childhood "G. Barresi", University Hospital of Messina, Messina, Italy
| | - Francesca Polito
- Department of Clinical & Experimental Medicine, University Hospital of Messina, Messina, Italy
| | - Arnaud Piquard
- Department of General, Endocrine and Thoracic Surgery, Regional Hospital of Orleans, Orléans, France
| | - Olivier Saint-Marc
- Department of General, Endocrine and Thoracic Surgery, Regional Hospital of Orleans, Orléans, France
| | - Maria Gioffre-Florio
- Department of Human Pathology in Adulthood and Childhood "G. Barresi", University Hospital of Messina, Messina, Italy
| | - Salvatore Benvenga
- Department of Clinical & Experimental Medicine, University Hospital of Messina, Messina, Italy.,Master Program on Childhood, Adolescent and Women's Endocrine Health, University Hospital of Messina, Messina, Italy.,Interdepartmental Program on Molecular & Clinical Endocrinology, and Women's Endocrine Health, University Hospital of Messina, Messina, Italy
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Abstract
AIM The preoperative diagnosis of differentiated thyroid carcinomas (DTC) is particularly challenging in view of the high prevalence of thyroid nodules in the general population. Incidental diagnosis of DTC, on the other hand, can lead to reoperations and increased risk of morbidity. This study aimed to assess the prediction value of preoperative DTC dignity assessment and it's impact on surgical approaches. METHODS We retrospectively reviewed 107 cases of DTC and subdivided them in three groups based on the preoperative dignity assessment: suspected malignancy (SM), unclear dignity (UD), and incidental findings (IF). The group differences were investigated in terms of diagnostic methods, findings, and impact on the subsequent surgical approach. RESULTS The patient groups consisted of n = 51 (SM), n = 32 (UD), and n = 24 (IF). The tumor size, T staging, and ultrasound (US) assessment had the largest impact on the dignity classification (each p < 0.001). Scintigraphy was performed in 80 % of the patients, fine-needle aspiration cytology (FNAC) in 28 %. Hypofunction at scintigraphy (p < 0.001) and cytology results (p < 0.01) were identified as significant predictors for group assignment. Other significant factors were the frequency of the US documentation of nodule characteristics (p < 0.001) and malignancy criteria (p < 0.01) as well as reduced thyroid-stimulating hormone (TSH) levels (p < 0.01). Frozen section (p < 0.001) and total thyroidectomy (p < 0.01) at initial surgery were performed significantly more often in the MV group. Reoperations were significantly more frequent in the IF group (p < 0.001). CONCLUSIONS A relevant number of DTC cases was diagnosed incidentally, leading to significantly more frequent reoperations. A more systematic diagnostic approach with complete documentation of the findings according to current guidelines should be pursued.
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Godoi Cavalheiro B, Kober Nogueira Leite A, Luongo de Matos L, Palermo Miazaki A, Marcel Ientile J, Aurelio V. Kulcsar M, Roberto Cernea C. Malignancy Rates in Thyroid Nodules Classified as Bethesda Categories III and IV: Retrospective Data from a Tertiary Center. Int J Endocrinol Metab 2018; 16:e12871. [PMID: 29696036 PMCID: PMC5903393 DOI: 10.5812/ijem.12871] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2017] [Revised: 11/14/2017] [Accepted: 11/22/2017] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Thyroid fine needle aspiration (FNA) has a well-established role in the diagnosis of thyroid nodules, and the "Bethesda system for reporting thyroid cytopathology" is used to interpret FNA results. Bethesda categories III and IV encompass varying risks of malignancy. In addition, there is some debate in the literature about how to select among many acceptable treatment approaches. OBJECTIVES To establish an association between these 2 cytological categories and malignancy rates in patients treated in a referral tertiary cancer center, where surgical treatment is recommended for all these patients. METHODS A total of 615 thyroid nodules (582 patients) were included in this retrospective study. There were 478 nodules that were classified as Bethesda category III and 137 nodules as Bethesda category IV. Electronic records were reviewed to establish a correlation between the FNA cytological results and the final histopathological analyses. Incidentally detected carcinomas were considered separately. RESULTS Among the bethesda category III group, 75 malignant nodules (15.7%) were coincident with the target nodule (74 patients, 16.2%). Incidental carcinomas were found in 13.8% of these patients. The remaining 403 (84.3%) target nodules were benign. Among the bethesda category IV nodules, 23 malignant nodules (16.8%) were coincident with the target nodule. Incidental carcinomas were found in 25 patients (19.7%). The other 114 target nodules were benign. A total of 46 patients (52.3%) had carcinomas in the thyroid lobe contralateral to the one containing the target nodule, and 40 patients (45.5%) had carcinomas exclusively in the contralateral lobe. CONCLUSIONS We observed a 16% rate of malignancy in nodules classified as bethesda category III and 17% among bethesda category IV. When incidental carcinomas were included, the rates of malignancy doubled.
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Affiliation(s)
- Beatriz Godoi Cavalheiro
- Head and Neck Surgery Department, Instituto do Cancer do Estado de Sao Paulo/Hospital das Clinicas da Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, Brasil
| | - Ana Kober Nogueira Leite
- Head and Neck Surgery Department, Instituto do Cancer do Estado de Sao Paulo/Hospital das Clinicas da Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, Brasil
- Corresponding author: Ana Kober Nogueira Leite, Av. Dr. Eneas de Carvalho Aguiar, 255 - 8th floor - room 8174, P. O. Box: 05403-000, Sao Paulo, Brazil;. Tel: +55-1130696425, Fax: +55-1130697506, E-mail:
| | - Leandro Luongo de Matos
- Head and Neck Surgery Department, Instituto do Cancer do Estado de Sao Paulo/Hospital das Clinicas da Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, Brasil
| | - Aline Palermo Miazaki
- Head and Neck Surgery Department, Instituto do Cancer do Estado de Sao Paulo/Hospital das Clinicas da Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, Brasil
| | - Jan Marcel Ientile
- Medical Student, Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, Brasil
| | - Marco Aurelio V. Kulcsar
- Head and Neck Surgery Department, Instituto do Cancer do Estado de Sao Paulo/Hospital das Clinicas da Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, Brasil
| | - Claudio Roberto Cernea
- Head and Neck Surgery Department, Instituto do Cancer do Estado de Sao Paulo/Hospital das Clinicas da Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, Brasil
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Kaliszewski K, Diakowska D, Strutyńska-Karpińska M, Wojtczak B, Domosławski P, Balcerzak W. Clinical and histopathological characteristics of patients with incidental and nonincidental thyroid cancer. Arch Med Sci 2017; 13:390-395. [PMID: 28261293 PMCID: PMC5332442 DOI: 10.5114/aoms.2016.59579] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2015] [Accepted: 08/24/2015] [Indexed: 12/12/2022] Open
Abstract
INTRODUCTION Thyroid nodules (TNs) are a common pathology. Their prevalence increases with age. Some of them are suspected of malignancy and qualified for surgery. Sometimes their malignant nature is detected incidentally after a surgical procedure. The aim of the study is to analyze clinical and histopathological characteristics of patients with incidental and nonincidental thyroid carcinoma (ITC vs. NITC). MATERIAL AND METHODS The case records of 3,241 patients with solitary and multiple TNs who were treated consecutively between 2008 and 2014 were analyzed retrospectively. After the final selection 235 (7.25%) patients were included in the study (202 females and 33 males, mean age: 52.9 +16.5 years). Seventy-five (31.91%) cases were incidentally diagnosed and 160 (68.09%) were diagnosed before surgery. RESULTS We did not observe any differences in age, gender or stage of disease at the time of diagnosis between the patients with ITC and NITC (p = 0.366, p = 0.850, p = 0.226 respectively). The occurrence of solitary nodules in patients with NITC was significantly higher compared to patients with ITC (p < 0.0001). There were no differences in histopathological types of thyroid cancer (TC). The logistic regression analysis showed that solitary TC was an independent predictor of NITC (p < 0.0001). CONCLUSIONS There are no differences in gender, age or histopathological type of cancer in patients with ITC and NITC. Papillary TC is the predominant type in both groups. Incidence of TC in a solitary nodule is significantly higher in NITC than ITC. Solitary type of TC is an independent predictor of NITC. The prevalence of ITC is associated with multifocal type of TC.
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Affiliation(s)
- Krzysztof Kaliszewski
- 1 Department and Clinic of General, Gastroenterological and Endocrine Surgery, Wroclaw Medical University, Wroclaw, Poland
| | - Dorota Diakowska
- Department and Clinic of Gastrointestinal and General Surgery, Wroclaw Medical University, Wroclaw, Poland
| | - Marta Strutyńska-Karpińska
- 1 Department and Clinic of General, Gastroenterological and Endocrine Surgery, Wroclaw Medical University, Wroclaw, Poland
| | - Beata Wojtczak
- 1 Department and Clinic of General, Gastroenterological and Endocrine Surgery, Wroclaw Medical University, Wroclaw, Poland
| | - Paweł Domosławski
- 1 Department and Clinic of General, Gastroenterological and Endocrine Surgery, Wroclaw Medical University, Wroclaw, Poland
| | - Waldemar Balcerzak
- 1 Department and Clinic of General, Gastroenterological and Endocrine Surgery, Wroclaw Medical University, Wroclaw, Poland
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18
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Incidental versus non-incidental thyroid carcinoma: Clinical presentation, surgical management and prognosis. ACTA ACUST UNITED AC 2016. [DOI: 10.1016/j.endoen.2016.10.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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González-Sánchez-Migallón E, Flores-Pastor B, Pérez-Guarinos CV, Miguel-Perelló J, Chaves-Benito A, Illán-Gómez F, Carrillo-Alcaraz A, Aguayo-Albasini JL. Incidental versus non-incidental thyroid carcinoma: Clinical presentation, surgical management and prognosis. ACTA ACUST UNITED AC 2016; 63:475-481. [PMID: 27426718 DOI: 10.1016/j.endonu.2016.05.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2015] [Revised: 05/06/2016] [Accepted: 05/20/2016] [Indexed: 12/12/2022]
Abstract
BACKGROUND AND OBJECTIVE Thyroid cancer may be clinically evident as a tumor mass in the neck or as a histopathological incidental finding after thyroid surgery for an apparent benign condition. Our objective was to assess the differences in clinical signs, surgical management, and course between incidental and clinically diagnosed thyroid tumors. METHODS A retrospective study was conducted on patients operated on for benign or malignant thyroid disease from January 2000 to March 2014. Among the 1415 patients who underwent any thyroid surgery, 264 neoplasms were found, of which 170 were incidental. A comparison was made of incidental versus non-incidental carcinomas. Among incidental carcinomas, cases whose indication for surgery was Graves' disease were compared to those with multinodular goiter. RESULTS Incidental carcinomas were in earlier stages and required less aggressive surgery. There were no differences in surgical complications between incidental and clinical tumors, but mortality and relapses were markedly higher in non-incidental cancers (4.4% vs 0% and 13.2% vs 4.8% respectively). Carcinomas developing on Graves' disease showed no differences from all other incidental tumors in terms of complications, mortality, or relapse after surgery. CONCLUSIONS Early stage thyroid cancer has better survival and prognosis after surgical treatment.
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Affiliation(s)
| | - Benito Flores-Pastor
- Servicio de Cirugía General, Hospital General Universitario J.M. Morales Meseguer, Universidad de Murcia, Murcia, España
| | - Carmen Victoria Pérez-Guarinos
- Servicio de Cirugía General, Hospital General Universitario J.M. Morales Meseguer, Universidad de Murcia, Murcia, España
| | - Joana Miguel-Perelló
- Servicio de Cirugía General, Hospital General Universitario J.M. Morales Meseguer, Universidad de Murcia, Murcia, España
| | - Asunción Chaves-Benito
- Servicio de Anatomía Patológica, Hospital General Universitario J.M. Morales Meseguer, Universidad de Murcia, Murcia, España
| | - Fátima Illán-Gómez
- Servicio de Endocrinología y Nutrición, Hospital General Universitario J.M. Morales Meseguer, Universidad de Murcia, Murcia, España
| | - Andrés Carrillo-Alcaraz
- Servicio de Medicina Intensiva, Hospital General Universitario J.M. Morales Meseguer, Universidad de Murcia, Murcia, España
| | - José Luis Aguayo-Albasini
- Servicio de Cirugía General, Hospital General Universitario J.M. Morales Meseguer, Universidad de Murcia, Murcia, España
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Ruggiero R, Docimo L, Tolone S, De Palma M, Musella M, Pezzolla A, Gubitosi A, Parmeggiani D, Pirozzi R, Gili S, Parisi S, D'Alessandro A, Docimo G. Effectiveness of an advanced hemostatic pad combined with harmonic scalpel in thyroid surgery. A prospective study. Int J Surg 2015; 28 Suppl 1:S17-21. [PMID: 26708861 DOI: 10.1016/j.ijsu.2015.12.044] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2015] [Revised: 04/26/2015] [Accepted: 05/15/2015] [Indexed: 02/08/2023]
Abstract
INTRODUCTION Hemostasis during thyroidectomy is essential; however the most efficient and cost-effective way to achieve this is unclear. The aim of this study was to evaluate the outcome of total thyroidectomy (TT) performed with the combination of harmonic scalpel (HS) and an advanced hemostatic pad (Hemopatch). METHODS Patient undergone TT were divided into two groups: HS + hemopatch and HS + traditional hemostasis groups. The primary endpoint was 24-h drain output and blood-loss requiring reintervention. Secondary endpoints included surgery duration, postsurgical complications and hypocalcemia rates. RESULTS Between September 2014 and March 2015, 60 patients were enrolled (30 to Hs + Hemopatch, 30 to Hs and standard hemostasis); 71.4% female; mean age 48.5 years. The 24-h drain output was lower in the HS + hemopatch group compared with standard TT. HS and hemopatch also had a shorter mean surgery time (p < 0.0001) vs standard TT. CONCLUSION combination of hemopatch plus HS is effective and safe for TT with a complementary hemostatic approach.
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Affiliation(s)
- Roberto Ruggiero
- Division of Surgery, Department of Surgery, Second University of Naples, Naples, Italy.
| | - Ludovico Docimo
- Division of Surgery, Department of Surgery, Second University of Naples, Naples, Italy
| | - Salvatore Tolone
- Division of Surgery, Department of Surgery, Second University of Naples, Naples, Italy
| | | | - Mario Musella
- Division of Surgery, Department of Surgery, Federico II University, Naples, Italy
| | | | - Adelmo Gubitosi
- Division of Surgery, Department of Surgery, Second University of Naples, Naples, Italy
| | - Domenico Parmeggiani
- Division of Surgery, Department of Surgery, Second University of Naples, Naples, Italy
| | - Raffaele Pirozzi
- Division of Surgery, Department of Surgery, Second University of Naples, Naples, Italy
| | - Simona Gili
- Division of Surgery, Department of Surgery, Second University of Naples, Naples, Italy
| | - Simona Parisi
- Division of Surgery, Department of Surgery, Second University of Naples, Naples, Italy
| | - Antonio D'Alessandro
- Division of Surgery, Department of Surgery, Second University of Naples, Naples, Italy
| | - Giovanni Docimo
- Division of Surgery, Department of Surgery, Second University of Naples, Naples, Italy
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